Provider Demographics
NPI:1114619517
Name:BLAYLOCK, ANDREA (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8863 SILVERBARK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7369
Mailing Address - Country:US
Mailing Address - Phone:901-268-1004
Mailing Address - Fax:
Practice Address - Street 1:2795 CHARLES BRYAN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4773
Practice Address - Country:US
Practice Address - Phone:901-386-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics